Role of Intraperitoneal Drainage after Laparoscopic Sleeve Gastrectomy

Abstract

Background and aims: Laparoscopic sleeve gastrectomy (LSG) is a very popular bariatric procedure. Intraperitoneal bleeding, haematoma and staple line leak are the most common postoperative complications of LSG. Many surgeons routinely leave an intraperitoneal drain (IPD) thinking it will help in managing complications. Our aim was to evaluate the role of IPD in diagnosing and treating post-operative complications after sleeve gastrectomy. Patients and methods: We collected the data of patients who underwent primary LSG at our department between February 2016 and March 2018. 120 patients (group A) had LSG with positioning of IPD and 105 patients (group B) had LSG without IPD. All operations were performed by the same operative team and were completed laparoscopically. Inclusion criteria were a body mass index (BMI) greater than 40 kg/m2 or greater than 35 kg/ m2 accompanied with relevant co-morbidities. Exclusion criteria were the inability to undergo general anesthesia, patients with previous bariatric procedures, patients with previous intragastric balloon, patients on anticoagulation and patients older than 60 years. Results: The two groups were not different in their outcome. In Group A, 3(2.5%) patients had bleeding ( only one was evident in the drain) managed conservatively, one(0.8%) of them later on had surgical bed haematoma treated by U/S guided aspiration and pigtail insertion. Also in group A, one case (0.8%) of leakage managed by endoscopic stent and laparoscopic lavage and draining. In Group B, 4 cases (3.8%) had bleeding managed conservatively, 2 of them (1.9%) had haematoma later on managed by U/S guided aspiration and pigtail insertion. No leakage occurred in group B. Conclusions: Insertion of drains does not help in diagnosing or treating post-LSG complications as bleeding, leakage or haematoma.